Carcinoma of the Skin - College of American Pathologists



Protocol for the Examination of Specimens From Patients With Squamous Cell Carcinoma of the Skin

Protocol applies to invasive squamous cell carcinomas of the skin. Squamous cell carcinomas of the eyelid, vulva, and penis are not included.

Based on AJCC/UICC TNM, 7th edition

Protocol web posting date: February 1, 2011

Procedures

• Biopsy

• Excision

• Re-excision

• Lymph node examination

Authors

Priya Rao, MD*

Department of Pathology, Cedars-Sinai Medical Center, Los Angeles, California

Bonnie L. Balzer, MD, PhD, FCAP

Department of Pathology, Cedars-Sinai Medical Center, Los Angeles, California

Nanette J. Liegeois, MD, PhD

Department of Dermatology, Johns Hopkins Medicine, Baltimore, Maryland

Jennifer M. McNiff, MD, FASCP

Departments of Dermatology and Pathology, Yale University School of Medicine, New Haven, Connecticut

Paul Nghiem, MD, PhD

Division of Dermatology, University of Washington Medical Center, Seattle, Washington

Victor G. Prieto, MD, PhD, FACP

Departments of Pathology and Dermatology, MD Anderson Cancer Center, University of Texas, Houston, Texas

M. Timothy Smith, MD

Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston, South Carolina

Bruce Robert Smoller, MD, FCAP

Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, Arkansas

Mark R. Wick, MD, FCAP

Department of Pathology, University of Virginia Health System, Charlottesville, Virginia

David Frishberg, MD, FCAP†

Department of Pathology, Cedars-Sinai Medical Center, Los Angeles, California

For the Members of the Cancer Committee, College of American Pathologists

*denotes primary author. † denotes senior author. All other contributing authors are listed alphabetically.

Previous contributors (Carcinoma of the skin): Mark R. Wick, MD; Carolyn Compton, MD, PhD; Lyn Duncan, MD; Harley A. Haynes, MD; Gregg M. Menaker, MD; Nicholas E. O’Connor, MD

© 2011 College of American Pathologists (CAP). All rights reserved.

The College does not permit reproduction of any substantial portion of these protocols without its written authorization. The College hereby authorizes use of these protocols by physicians and other health care providers in reporting on surgical specimens, in teaching, and in carrying out medical research for nonprofit purposes. This authorization does not extend to reproduction or other use of any substantial portion of these protocols for commercial purposes without the written consent of the College.

The CAP also authorizes physicians and other health care practitioners to make modified versions of the Protocols solely for their individual use in reporting on surgical specimens for individual patients, teaching, and carrying out medical research for non-profit purposes.

The CAP further authorizes the following uses by physicians and other health care practitioners, in reporting on surgical specimens for individual patients, in teaching, and in carrying out medical research for non-profit purposes: (1) Dictation from the original or modified protocols for the purposes of creating a text-based patient record on paper, or in a word processing document; (2) Copying from the original or modified protocols into a text-based patient record on paper, or in a word processing document; (3) The use of a computerized system for items (1) and (2), provided that the Protocol data is stored intact as a single text-based document, and is not stored as multiple discrete data fields.

Other than uses (1), (2), and (3) above, the CAP does not authorize any use of the Protocols in electronic medical records systems, pathology informatics systems, cancer registry computer systems, computerized databases, mappings between coding works, or any computerized system without a written license from CAP. Applications for such a license should be addressed to the SNOMED Terminology Solutions division of the CAP.

Any public dissemination of the original or modified Protocols is prohibited without a written license from the CAP.

The College of American Pathologists offers these protocols to assist pathologists in providing clinically useful and relevant information when reporting results of surgical specimen examinations of surgical specimens. The College regards the reporting elements in the “Surgical Pathology Cancer Case Summary (Checklist)” portion of the protocols as essential elements of the pathology report. However, the manner in which these elements are reported is at the discretion of each specific pathologist, taking into account clinician preferences, institutional policies, and individual practice.

The College developed these protocols as an educational tool to assist pathologists in the useful reporting of relevant information. It did not issue the protocols for use in litigation, reimbursement, or other contexts. Nevertheless, the College recognizes that the protocols might be used by hospitals, attorneys, payers, and others. Indeed, effective January 1, 2004, the Commission on Cancer of the American College of Surgeons mandated the use of the checklist elements of the protocols as part of its Cancer Program Standards for Approved Cancer Programs. Therefore, it becomes even more important for pathologists to familiarize themselves with these documents. At the same time, the College cautions that use of the protocols other than for their intended educational purpose may involve additional considerations that are beyond the scope of this document.

The inclusion of a product name or service in a CAP publication should not be construed as an endorsement of such product or service, nor is failure to include the name of a product or service to be construed as disapproval.

Important Note

This protocol supersedes some elements of the previous College of American Pathologists carcinoma of the skin protocol,1 last revised in 2005, which was optional for squamous cell carcinomas. This new protocol is required only for tumors >2 cm in greatest dimension (which are automatically at least pT2 lesions) and is applicable to squamous cell carcinoma only.

Currently, most cancer registrars do not routinely report cutaneous squamous cell carcinomas. Nevertheless, there is an evolving standard of practice in dermatopathology to report invasive squamous carcinomas in a templated manner (see especially Khanna et al2); this checklist is intended to be helpful in developing such templates.

Important changes include:

Assignment of pT2 has been changed to reflect a combination of size and “high risk factors” (see note F).

pT3 and PT4 categories have been re-defined, and are assigned on the basis of invasion of specific structures (see note F).

Nodal involvement (previous pN1) has been subdivided into N1, N2, and N3, based on number, size, and site (ipsilateral, contralateral, bilateral) of involved nodes (see note F).

CAP Squamous Cell Carcinoma Protocol Revision History

Version Code

The definition of version code can be found at cancerprotocols.

Version: SquamousCell 3.1.0.0

The following changes have been made since the February 2010 release.

Biopsy, Excision, Re-excision, Lymphadenectomy Checklist

Margins

Peripheral Margins

Uninvolved by invasive carcinoma: The word “lateral” was changed to “peripheral”; Uninvolved by carcinoma in situ: The word “peripheral” was added, as follows:

___ Uninvolved by invasive carcinoma

*Distance of invasive carcinoma from closest peripheral margin: ___ mm

___ Uninvolved by carcinoma in situ

*Distance of carcinoma in situ from closest peripheral margin: ___ mm

Lymph Nodes

Number of nodes examined / Number of nodes involved, has been changed to:

___ No nodes submitted or found

Number of Lymph Nodes Examined

Specify: ____

___ Number cannot be determined (explain): ______________________

Number of Lymph Nodes Involved By Metastatic Carcinoma

Specify: ____

___ Number cannot be determined (explain): ______________________

Explanatory Notes

A. Anatomic Site. The word “glabrous” was changed to “hair-bearing.”

D. High-Risk Histologic Features. The word “depth” was changed to “thickness.”

F. TNM and Stage Groupings

High-Risk Features for Primary (T) Tumor Staging

The word The word “glabrous” was changed to “hair-bearing.” The word “depth” was changed to “thickness.”

The following changes have been made since the October 2009 release.

Explanatory Notes

Note F. The histologic high-risk factor was changed from ≥4 mm to ≥2 mm.

Surgical Pathology Cancer Case Summary (Checklist)

Protocol web posting date: February 1, 2011

SQUAMOUS CELL CARCINOMA OF THE SKIN: Biopsy, Excision, Re-excision, Lymphadenectomy

Note: Use of checklist is optional for tumors ................
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In order to avoid copyright disputes, this page is only a partial summary.

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